Adolescents Do Not Use the Health Care System Enough

Exam roomAdolescents have one of the lowest rates of primary care use of any age group in the United States.1 and adolescents from disadvantaged backgrounds are at the highest risk of not having regular health maintenance visits.2, 3

Children from low-income families experience disparities in health, which are due in part to barriers in access and utilization of health care. Poor health care access and utilization is influenced by factors including lack of health care providers, the intricacies of navigating a complex health care system, language barriers, and transportation.4

Being part of a racial or ethnic minority group, being poor, or being in a family that has recently immigrated to the United States may also contribute to decreased access to quality and appropriate health services.5

The highest standard of adolescent care, according to the American Academy of Pediatrics’ Committee on Adolescence, includes anticipatory guidance, screening, and counseling to reduce risks and increase health promoting behaviors. But such a standard is rarely achieved today; far too many adolescents, in fact, rely on our most costly delivery settings: emergency departments.6, 7

SBHCs Increase Access to Health Care

School-based health centers (SBHCs) are considered one of the most effective strategies for delivering preventive care, including reproductive and mental health care services, to adolescents—a population long considered difficult to reach. Numerous evaluations have shown that SBHCs achieve marked improvements in adolescent health care access when compared with adolescent utilization in other settings. This is especially true for important services delivered on-site, such as family planning, screening and counseling for sexually transmitted diseases, mental health, and substance abuse services.8, 9, 10, 11, 12, 13

A national multi-site study of school-based health centers conducted by Mathmatica Policy Research found a significant increase in health care access by students who used school-based health centers: 71 percent of students reported having a health care visit in past year compared to 59 percent of students who did not have access to an SBHC.14 Periodic surveys of SBHCs show that adolescents seen in SBHCs are likely to receive recommended services such as abstinence counseling (76 percent), pregnancy testing (78 percent), crisis intervention (91 percent), STD testing and treatment (62 percent), mental health assessment and diagnosis (91percent), and substance abuse counseling (77 percent). In contrast, state and local policies limit recommended adolescent services: oral contraceptives are available in 30 percent of SBHCs, pap smears in 42 percent, and HIV testing in 44 percent.15


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(7)   {National Committee for Quality Assurance, 2010 #3957}
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(15) Lofink H, Kuebler J, Juszczak L, et al. 2010-2011 School-Based Health Alliance Census Report. Washington, DC: School-Based Health Alliance;2013.